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The Evasive Influence of Nurse-Patient Communication

Created Jun 22 2016, 08:00 PM by Lippincott Solutions
  • nurse-patient communication
  • HCAHPS
  • Patient satisfaction

Thursday, June 23, 2016

Strong communication skills have always been essential for nurses. Collecting patient information, easing anxiety and distress, and educating the patient and their loved ones on the progress of their care as well as how to manage it after they transfer to home are key nursing functions that rely on effective nurse-patient interaction.

Long categorized as a “soft skill” — one that is difficult to measure, as opposed to a “hard skill,” which is more easily quantifiable (say, diabetes education or acute care knowledge) — communication by nurses is becoming increasingly assessed. Patient questionnaires such as the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey measure the effectiveness of nurse-patient communication (in the patient’s view, at any rate), which goes on to affect the Medicare reimbursement a hospital receives.

This soft skill has showed to have a real impact on a hospital’s bottom line.

CONCISE, CONSISTENT COMMUNICATION

Recognizing this, and noticing that its HCAHPS scores weren’t as high as they’d prefer, nurse leaders at a community hospital in Eastern Pennsylvania offered nurses some communication training. They chose the Support, Empathy, Truth (SET) tool.

“Initially developed for use with patients in a mental health setting, the tool is designed to enable clinicians to use concise, consistent communication,” they explained in the March issue of Nursing Management.

Here’s a brief look at how it works.

  • To support the patient, the nurse first offers a statement of concern or a pledge to be helpful. The focus is on the nurse’s feelings, not the patient’s. For example, “I’m worried about your level of pain.”
  • An empathy statement follows, which addresses the patient’s experience in a neutral way. “Tell me about your pain and how you relieve it.”
  • Finally, a truth component acknowledges the issue in a matter-of-fact way, avoids blame, and seeks a solution. According to the article authors, this is the trickiest yet most pivotal part of the conversation. They provide this example: “How are you going to manage your pain effectively at home?”

A big SET no no? “I know how you feel.” A statement like that sets the stage for criticism from patients and families who may feel it frustratingly necessary to point out that, no, you actually don’t know how they feel. An offhand remark like that can accomplish the exact opposite of the good vibes and understanding support the intervention intends to generate.

The nurses who volunteered to receive SET training watched a slide presentation, participated in role playing and discussed commonly encountered clinical scenarios. All in all, the prep took an hour of the nurses’ time.

PRACTICAL TAKEAWAYS

A focus group of a handful of nurses that underwent the training provided some valuable takeaways from the intervention, such as the importance of:

  • allowing patients to grieve and air their concerns and frustrations,
  • replacing “I know how you feel” statements with a simple rephrasing of what the patient said,
  • presenting information in a caring way,
  • being truthful rather than sugar-coating the situation,
  • being personal and building relationships with patients,
  • learning who patients are and not just aspects of their health,
  • leaving personal problems at home, and
  • working together with other nurses as a team.

 “The nurses viewed SET communication as a valuable resource to help build stronger rapport and improve the relationships between nurses, patients, and families,” the authors wrote.

Interestingly, when nurse leaders attempted to measure the intervention’s impact on three patient survey questions that centered on nurse-patient communication (two from HCAHPS and one from another questionnaire), the results were mixed and inconsistent.

Perhaps this goes to show that as important as communication and people skills are to patient care, the skills truly are soft and evasive to measure. In this data-driven age, that might prove a difficult concept to accept.

How do you quantify whether nurse-patient interaction at your hospital is effective?

  • A good way to communicate with your patient is to learn all the advanced methods of communication skills. This way, you will be able to communicate with your patient in the right way without having interfered with your languages.

  • The good side of learning good communication when developing your profession is to communicate well with the other people. Perhaps, this one goes to show that communication is so important for individual to adapt.

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